Laparoscopic gallbladder extraction device

ABSTRACT

A surgical instrument for removing a gallbladder is provided. The surgical instrument includes a handle assembly, an elongated body portion extending distally from the handle assembly, and a capture portion operably mounted on a distal end of the elongated body portion. The capture portion defines a tissue receiving opening when in an open configuration and is configured for receipt through an incision when in the capture portion is in a closed configuration. The capture portion includes at least one sharpened member for cutting tissue received within the tissue receiving opening as the capture portion moves from the open configuration to the closed configuration. Also provided is a method of removing a gallbladder using a surgical instrument.

CROSS-REFERENCE TO RELATED APPLICATION

The present application claims the benefit of and priority to U.S.Provisional Patent Application Ser. No. 61/679,036, filed Aug. 2, 2012,the content of which is incorporated herein by reference in itsentirety.

BACKGROUND

Technical Field

The present disclosure relates to instruments and methods for theremoval of a gallbladder. More specifically, the present disclosurerelates to a laparoscopic instrument for use in the removal of agallbladder.

Background of Related Art

Laparoscopic cholecystectomy is the most commonly performed minimallyinvasive surgical procedure with over 500,000 surgeries performedannually in the U.S. alone. During a laparoscopic cholecystectomyprocedure, after detachment, the gallbladder is removed through a trocarincision. To prevent bile from leaking from the gallbladder, thedetached gallbladder is typically placed in a retrieval bag. Whenretrieval bags are unavailable, surgical teams may create a substituteusing a latex glove. If a surgeon is unsuccessful at removing thegallbladder from the incision laparoscopically, the surgeon may oftenhave to enlarge the incision with a scalpel, extract the bile out of thegallbladder using a syringe, and/or use clamps to pull the gallbladderout piece by piece. Gallbladders that are full of bile and/or stonesand/or are too large to be easily pulled out through a laparoscopicincision make require as much as an additional 5-30 minutes of thesurgical team's time. Extra time may also be required to clean up anyspills. Caution is usually taken to prevent rupturing of the gallbladderupon extraction because bile and gallstones are toxic to internal tissueif not properly cleaned.

Therefore, during laparoscopic cholecystectomies there is a need for atime-efficient method that allows surgeons to remove the detachedgallbladder through an incision in the abdominal wall created for atrocar without spilling any bile and/or stones from the gallbladder.

SUMMARY

Accordingly, a surgical instrument for removing a gallbladder isprovided. The surgical instrument includes a handle assembly, anelongated body portion extending distally from the handle assembly, anda capture portion operably mounted on a distal end of the elongated bodyportion. The capture portion defines a tissue receiving opening when inan open configuration and is configured for receipt through an incisionwhen in the capture portion is in a closed configuration. The captureportion includes at least one sharpened member for cutting tissuereceived within the tissue receiving opening as the capture portionmoves from the open configuration to the closed configuration.

In one embodiment, the tissue capture portion includes a plurality ofcapture sections. The plurality of capture sections may form alongitudinal cylinder when the capture portion is in a closedconfiguration. Each of the capture sections may be operably connected toa linkage system for moving the capture sections between the closedconfiguration and the open configurations. Each linkage assembly mayinclude a proximal linkage member and a distal linkage member. Each ofthe proximal and distal linkage members may be operably connected to aninner shaft. The at least one sharpened member may be formed on thedistal linkage member. The handle assembly may include a trigger forclosing the capture portion. The handle assembly may include a releasemember for opening the capture portion. The elongated body portion mayinclude an inner shaft and an outer shaft.

Also provided is a method of removing tissue from within a body cavity.The method includes a step of providing a surgical instrument includinga capture portion operably mounted on a distal end of an elongated bodyportion. The capture portion defines a tissue receiving opening when inan open configuration and being configured for receipt through anincision when in a closed configuration. The capture portion may includeat least one sharpened member for cutting tissue received within thetissue receiving opening as the capture portion moves from the openconfiguration to the closed configuration. The method further includesthe steps of inserting the capture portion of the surgical instrumentthrough an incision, positioning tissue within the tissue receivingopening of the capture portion, placing a retrieval bag about thecapture portion of the surgical instrument, moving the capture portionfrom the open configuration to the closed configuration to cause theengagement of the sharpened member with the tissue, and removing thecapture portion through the incision.

In one embodiment, the step of receiving the capture portion of thesurgical instrument through the incision is performed when the captureportion is in the closed configuration. The step of placing theretrieval bag about the capture portion of the surgical instrument mayinclude sealing the retrieval bag about the capture portion to preventleakage. In addition, the step of inserting the capture portion of thesurgical instrument through an incision may be facilitated through theuse of an access port.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate embodiments of the disclosureand, together with a general description of the disclosure given above,and the detailed description of the embodiments given below, serve toexplain the principles of the disclosure, wherein:

FIG. 1 is a perspective view of a surgical instrument in accordance withan embodiment of the present disclosure, with a capture portion in afirst or closed condition;

FIG. 2 is a perspective view of the surgical instrument of FIG. 1, withthe capture portion in a second or open condition;

FIG. 3 is an enlarged perspective view of the distal end of the surgicalinstrument of FIGS. 1 and 2, with two of three linkage assembliesremoved to show the operation of the third linkage assembly;

FIG. 4 is an enlarged exploded view of the distal end of the surgicalinstrument of FIG. 3;

FIG. 5 is perspective view of the capture portion of the surgicalinstrument of FIGS. 1 and 2, in a first or closed configuration;

FIG. 6 is a perspective view of a single linkage assembly of the captureportion of the surgical instrument of FIGS. 1 and 2;

FIG. 7 is an enlarged exploded perspective view of an actuationmechanism according to one embodiment of the present disclosure;

FIG. 8 is an enlarged perspective view of the actuation mechanism ofFIG. 7, as assembled for use;

FIG. 9 is an enlarged cut-away side view of a handle assembly includingan actuation mechanism according to an alternative embodiment of thepresent disclosure; and

FIGS. 10-13 are perspective views of the surgical instrument in FIGS. 1and 2 in use during a gallbladder removal procedure.

DETAILED DESCRIPTION

Embodiments of the presently disclosed surgical instrument in accordancewith the present disclosure will now be described in detail withreference to the drawings wherein like reference numerals identifysimilar or identical structural elements. As used herein, as istraditional, the term “proximal” refers to the end of the instrumentwhich is closer to the user and the term distal refers to the end of theinstrument which is further away from the user.

FIGS. 1-6 illustrate an embodiment of the presently disclosed instrumentfor use in laparoscopic cholecystectomies and is shown generally assurgical instrument 100. With reference to FIGS. 1 and 2, surgicalinstrument 100 includes a handle assembly 110, an elongated body 130extending distally from handle assembly 110, and a capture portion 160operably mounted on a distal end of elongated body 130. As will bediscussed in further detail below, elongated body 130 and captureportion 160 of surgical instrument 100 are configured to be receivedthrough an incision “I” (FIG. 11) or access port (not shown) when in afirst or closed configuration (FIG. 1).

With continued reference to FIGS. 1 and 2, handle assembly 110 includesa fixed handle 112 and a trigger 114. As will be discussed in furtherdetail below, repeated refraction of trigger 114 relative to fixedhandle 112 causes closure of capture portion 160. Handle assembly 110further includes an actuation assembly 120 (FIGS. 7 and 8). As also willbe discussed in further detail below, actuation assembly 120 isconfigured to permit the selective closure of capture portion 160. Arelease member 116 extends from handle assembly 110 and is configured topermit the opening of capture portion 160.

With reference now to FIG. 3, elongated body 130 of surgical instrument100 includes an outer shaft 132 and an inner shaft 140. Outer shaft 132includes a substantially cylindrical body defining a longitudinalpassageway 133 therethrough configured to receive inner shaft 140. Adistal end of outer shaft 132 includes a cylindrical flange 134 anddefines a plurality of longitudinal windows or slots 135 extendingproximal of cylindrical flange 134. Although shown having three windows135, as will become apparent below, outer shaft 132 may define only twowindows or may include four or more windows. A proximal end of eachlongitudinal window 135 is formed by a distal facing surface 136 ofouter tube 132. A distal end of each longitudinal window 135 is formedby a proximal facing surface 138 of cylindrical flange 134. As will bedescribed in further detail below, distal facing surfaces 136 of outershaft 132 facilitate the closing of capture portion 160, while proximalfacing surfaces 138 of cylindrical flange 134 facilitates opening ofcapture portion 160.

With reference now to FIGS. 4-6, inner shaft 140 includes an elongatedmember 142 having a proximal end 144 operably connected to handleassembly 110 (FIG. 1) and a distal end 146 operably connected to captureportion 160. Inner shaft 140 is configured to reciprocate within outershaft 132 to effect the operation of capture portion 160. As shown,distal end 146 of elongated member 142 includes a plurality of sides 142a, 142 b, 142 c, forming a triangular cross-section. As will bediscussed in further detail below, the number of sides of elongatedmember 142 corresponds to the number of longitudinal windows 135 formedin the distal end of outer shaft 132. Each of sides 142 a, 142 b, 142 cof elongated member 142 includes a proximal flange 148 a, 148 b, 148 cspaced proximally of distal end 146 and a distal flange 150 a, 150 b,150 c formed on distal end 146. Each flange 148 a, 148 b, 148 c, 150 a,150 b, 150 c defines an opening 147 a, 147 b, 147 c, 149 a, 14 b, 149 c,respectively. Proximal flanges 148 a, 148 b, 148 c and distal flanges150 a, 150 b, 150 c are each configured for operable connection withcapture portion 160.

With continued reference to FIGS. 4-6, capture portion 160 includes aplurality of longitudinal capture sections 162 a, 162 b, 162 c. Asshown, capture portion 160 includes three capture sections 162 a, 162 b,162 c, however, it is envisioned that alternative embodiments of thepresent disclosure may have as few as two capture sections or four ormore capture sections. Capture sections 162 a, 162 b, 162 c areconfigured to fit together to form a substantially cylindrical body 162when surgical instrument 100 is in the first or closed condition (FIG.1). In this manner, capture portion 160 is configured to be receivedthrough an incision “I” (FIG. 10) or trocar assembly. Capture portion160 is further configured such that capture sections 162 a, 162 b, 162 cmay be radially spaced apart to form a tissue receiving space 161therebetween when capture portion 160 is in a second or open condition(FIG. 2).

With reference still to FIGS. 4-6, each of capture sections 162 a, 162b, 162 c is operably connected to distal end 146 of inner shaft 142 by alinkage assembly 164 a, 164 b, 164 c (FIG. 5). Linkage assemblies 164 a,164 b, 164 c operate to maintain capture sections 162 a, 162 b, 162 c inparallel relation throughout the opening and closing of capture portion160. Each of linkage assemblies 164 a, 164 b, 164 c are substantiallysimilar and therefore will only be described as relates to linkageassembly 164 a. Linkage assembly 164 a includes a proximal linkagemember 166 a and a distal linkage member 172 a. A proximal end 168 a ofproximal linkage member 166 a is configured for pivotal connection withproximal flange 148 a of inner shaft 142 and a proximal end 174 a ofdistal linkage member 172 a is configured for pivotal connection withdistal flange 150 a of inner shaft 142. In one embodiment, and as shown,proximal end 168 a of proximal linkage member 166 a and proximal end 174a of distal linkage member 172 a each define an opening 167 a, 173 a,respectively. A linkage pin 152 a is received through opening 147 a inproximal flange 148 a and opening 167 a in proximal end 168 a ofproximal linkage member 166 a and a linkage pin 154 a is receivedthrough opening 149 a in distal flange 150 a and opening 173 a inproximal end 174 a of distal linkage member 172 a to pivotally secureproximal end 168 a of proximal linkage member 166 a and proximal end 174a of distal linkage member 172 a, respectively, to distal end 146 ofinner shaft 142. Proximal ends 168 a, 174 a of proximal and distallinkage members 166 a, 172 a, respectively, may further include a forkedconfiguration, as shown, to reinforce and/or stabilize the pivotalconnection between proximal and distal linkage members 166 a, 172 a,respectively, and distal end 146 of inner shaft 142.

With reference still to FIGS. 4-6, distal ends 170 a, 176 a of proximaland distal linkage members 166 a, 172 a, respectively, each define anopening 169 a, 175 a, respectively. Each of openings 169 a, 175 a isconfigured to receive a linkage pin 180 a, 182 a, respectively. Aproximal end of capture section 162 a defines a pair of openings 161 a,163 a. Proximal linkage member 166 a is pivotally secured to capturesection 162 a when linkage pin 180 a is received through opening 169 ain distal end 170 a of proximal linkage member 166 a and through opening161 a in capture section 162 a. Similarly, distal linkage member 172 ais pivotally secured to capture section 162 a when linkage pin 182 a isreceived through opening 175 a in distal end 176 a of distal linkagemember 172 a and through opening 163 a in capture section 162 a.

With reference to FIGS. 3-6, distal linkage member 172 a includes asharpened member 178 a on a radially inward facing section thereof whensurgical instrument 100 is in the first or closed configuration (FIG.1). Sharpened member 178 a is configured to engage and to cut anincision in a gallbladder or other tissue received within captureportion 160 as capture sections 162 a, 162 b, 162 c are approximatedtowards one another. Sharpened member 178 a is sufficiently angled tocut a gallbladder or other tissue without a large forcing having to beapplied by capture portion 160, but is not so sharp as to accidently cutthe gallbladder or other tissue through incidental contact and prior tothe closing of capture portion 160. In one embodiment, sharpened member178 a may form an angle between ten degrees (10°) and fifty degrees(50°), in another embodiment the angle of sharpened member 178 a may bebetween twenty degrees (20°) and forty degrees (40°), and in yet anotherembodiment, sharpened member 178 a may have an angle of thirty degrees(30°).

With particular reference now to FIG. 3, as shown, linkage assembly 164a operably connects capture section 162 a to distal end 146 of innershaft 142. Distal end 146 of inner shaft 140 extends through cylindricalflange 134 on the distal end of outer shaft 132. Inner shaft 140 isoriented such that proximal flange 148 a is aligned with one of windows135. In this manner, proximal end 168 a of proximal linkage member 166 amay be received through window 135 and be pivotally connected toproximal flange 148 a by linkage pin 152 a received through opening 167a (FIG. 4) in proximal end 168 a of proximal linkage member 166 a andopening 147 a in proximal flange 148 a. Distal end 170 a of proximallinkage member 166 a is pivotally secured to capture section 162 a bylinkage pin 180 a received through opening 161 a (FIG. 4) in capturesection 162 a and opening 169 a in distal end 170 a of proximal linkagemember 166 a.

With particular reference still to FIGS. 3 and 4, proximal end 174 a ofdistal linkage member 172 a is pivotally connected to distal flange 150a on proximal end 146 of inner shaft 140 by linkage pin 154 a receivedthrough opening 173 a in proximal end 174 a of distal linkage assembly172 a and opening 149 a in distal flange 150 a. Distal end 176 a ofdistal linkage member 172 a is pivotally secured to capture section 162a by linkage pin 182 a received through opening 163 a in capture section162 a and opening 175 a in distal end 176 a of distal linkage member 172a.

Still referring to FIGS. 3 and 4, the operation of capture portion 160will now be described with reference to capture section 162 a andlinkage assembly 164 a. During opening of capture portion 160 innershaft 140 is advanced distally, as indicated by arrow “A” (FIG. 3), tocause pivoting of proximal and distal linkage members 166 a, 172 a. Asinner shaft 140 is advanced distally, proximal linkage member 172 aengages proximal facing surface 138 of cylindrical flange 134 formingthe distal end of window 135. Engagement of proximal facing surface 138by proximal linkage member 166 a causes proximal linkage member 166 a topivot in a clockwise direction about proximal flange 148 a, as indicatedby arrow “B” (FIG. 3).

During closing of capture portion 160, inner shaft 142 is refractedproximally, as indicated by arrow “C” (FIG. 3). As inner shaft 142 isretracted proximally, proximal linkage member 172 a engages distalfacing surface 136 of outer shaft 132 forming the proximal end of window135. Engagement of distal facing surface 136 by proximal linkage member166 a causes proximal linkage member 166 a to pivot in acounter-clockwise direction about proximal flange 148 a, as indicated byarrow “D”. As discussed above, linkage assembly 164 a is configured suchthat capture section 162 a is maintained parallel to elongated body 130throughout the opening and closing of capture portion 160.

With reference now to FIGS. 7 and 8, an actuation assembly 120 forcontrolling the opening and closing of capture portion 160 is shown.Actuation assembly 120 includes trigger 114, a first plate 122, a secondplate 124, a first spring 126 for biasing first plate 122 proximally anda second spring 128 for biasing second plate 124 distally. Trigger 114includes a horizontal extension 118 a and a vertical extension 118 b.Horizontal extension 118 a is configured to press against second plate124 when trigger 114 is squeezed. Vertical extension 118 b is configuredto press against first plate 122 when trigger 114 is squeezed. Each offirst and second plates 122, 124 define a diamond-shaped opening 123,125 for receiving proximal end 144 of inner shaft 140. As shown,proximal end 144 of inner shaft 140 includes a substantially hexagonallongitudinal cross-section configured for selective engagement withinopenings 123, 125 of first and second plates 122, 124, respectively.

With particular reference now to FIG. 8, squeezing of trigger 114, asindicated by arrow “E” causes proximal retraction of inner shaft 140, asindicated by arrow “C”. First plate 122 is inclined relative to innershaft 140 due to the force from first spring 126. The friction forcebetween inner shaft 140 and first plate 122 prevents inner shaft 140from advancing distally as the inclined angle of first plate 122increases the friction force between inner shaft 140 and first plate122. In this manner, to permit distal advancement of inner shaft 140,first plate 122 must be pulled counter-clockwise, as indicated by arrow“G”. As trigger 114 is squeezed, horizontal extension 118 a engagessecond plate 124, causing second plate 124 to pivot counter-clockwise,as indicated by arrow “F”. The engagement of second plate 124 with innershaft 140 causes proximal refraction of inner shaft 140 as second plate124 is pivoted. Engagement of vertical extension 118 b of trigger 114 astrigger 114 is squeezed causes first plate 122 to pivotcounter-clockwise, as indicated by arrow “G”. As noted above,counter-clockwise movement of first plate 122 reduces the friction forcebetween first plate 122 and inner shaft 140, thereby permitting distaladvancement by inner shaft 140.

After the surgeon releases the trigger 114, second spring 128 pushessecond plate 124 to its original position, thereby also returningtrigger 114 to its original position. First spring 126 pushes firstplate 122 back to an initial position, thereby increasing the frictionforce between first plate 122 and inner shaft 140 to prevent distaladvancement of inner shaft 140. Actuation assembly 120 may be configuredsuch that closing of capture portion 160 requires that trigger 114 besqueezed only a single time. Alternatively, the closure of captureportion 160 may require repeated squeezing of trigger 114. In oneembodiment, actuation assembly 120 is configured such that completeclosure of capture portion 160 requires that trigger 114 is squeezedthree times. In this manner, capture portion 160 may be incrementallyclosed about a gallbladder or other tissue. In some embodiments, innershaft 140 is biased in the distal direction by a spring (not shown), tocause the opening of capture portion 160 when inner shaft 140 is notprevented from movement by first plate 122.

With reference now to FIG. 9, an alternative embodiment of actuationassembly according to the present disclosure is shown generally asactuation assembly 120′. Actuation assembly 120′ is substantiallysimilar to actuation assembly 120 and will be described with regardthereto. Actuation assembly 120′ includes a proximal plate 122′, adistal plate 124′, a first spring 126′ and a second spring 128′. Each ofproximal and distal plates 122′, 124′ define an opening (not shown) forreceipt of a proximal end 144′ of an inner shaft 142′. First plate 122′operates in a manner similar to second plate 124 of actuation assembly120. Squeezing of trigger 114′ causes first plate 122′ to pivot, therebyretracting inner shaft 140′ proximally. Second plate 124′ operates in amanner similar to first plate 122 of actuation assembly 120. Secondplate 124′ engages inner shaft 140′ to prevent distal advancement ofinner shaft 140′. Clockwise movement of second plate 124′, as indicatedby arrow “H”, causes the release of inner shaft 140′. Inner shaft 140′may be biased distally by a spring (not shown) to open capture portion160 (FIG. 1) when inner shaft 140′ is not prevented from advancingdistally by second plate 124′. Alternatively, a surgeon may advanceinner shaft 140′ distally by pushing on proximal end 144′ of inner shaft140′ while maintaining second plate 124′ in a release position.

The use of surgical instrument 100 for the removal of a gallbladder orother tissue within the abdominal cavity will now be described withreference to FIGS. 10-13. Referring initially to FIG. 10, an incision“I” is cut in tissue “T” to access the abdominal cavity “AC” of apatient. As discussed above, elongated body 130 and capture portion 160are configured to be received through incision “I” or through a trocarassembly (not shown). Capture portion 160 of surgical instrument 100 isthen directed through incision “I”.

Turning to FIG. 11, once capture portion 160 has been received withinabdominal cavity “AC”, handle assembly 110 is actuated to cause theopening of capture portion 160. This is accomplished by pressing releasemember 116 in a counter clockwise motion to disengage first plate 122(FIG. 8) from inner shaft 140, thereby permitting distal advancement ofinner shaft 140 and opening of capture portion 160. As discussed above,inner shaft 140 may be distally biased by a spring or other mechanism(not shown) such that capture portion 160 opens upon pressing of releasemember 116.

With reference now to FIG. 12, after opening capture portion 160, agallbladder “GB” or other tissue may be received within tissue receivingspace 161 between capture sections 162 a, 162 b, 162 c of captureportion 160. In some embodiments, trigger 114 may be squeezed one ormore times to reduce the size of tissue receiving space 161 toaccommodate gallbladders “GB” and other tissue of different sizes.

Turning to FIG. 13, once gallbladder “GB” or other tissue has beensecurely received within tissue receiving space 161 of capture portion160, a retrieval bag “RB” or other suitable container is placed aboutcapture portion 160. Retrieval bag “RB” is then securely closed toprevent the leakage of bile, stones or other tissue. Trigger 114 maythen be further squeezed to cause the closure of capture portion 160,thereby compressing gallbladder “GB”. As capture portion 160 moves to aclosed configuration, sharpened members 178 formed on each of distallinkage members 172 engage and cut gallbladder “GB” to permit the bileand/or stones contained within gallbladder “GB” to drain into retrievalbag “RB”. Once capture portion 160 achieves a closed position, captureportion 160, including retrieval bag “RB” and gallbladder “GB”, may beremoved through incision “I”. Incision “I” may then be closed in atraditional manner.

Although the illustrative embodiments of the present disclosure havebeen described herein with reference to the accompanying drawings, it isto be understood that the disclosure is not limited to those preciseembodiments, and that various other changes and modifications may beeffected therein by one skilled in the art without departing from thescope or spirit of the disclosure. For example, it is envisioned thatthe gallbladder may be received within a retrieval bag prior to beingreceived within capture portion 160. In this manner, sharpened members178 of capture portion 160 are dulled to prevent cutting of theretrieval bag and the gall bladder is burst during closure of captureportion 160.

The invention claimed is:
 1. A surgical instrument comprising: a handleassembly; an elongated body portion extending distally from the handleassembly; a capture portion operably mounted on a distal end of theelongated body portion, the capture portion including at least threecapture sections extending parallel to one another and defining a tissuereceiving opening having a first dimension when the capture portion isin an open configuration and a second dimension when the capture portionis in a closed configuration, the capture portion being configured forreceipt through an incision when in the closed configuration, whereinthe capture portion includes at least one sharpened member for cuttingtissue received within the tissue receiving opening as the captureportion moves from the open configuration to the closed configurationand the at least three capture sections remain parallel as the captureportion moves between the open configuration and closed configuration;and a linkage assembly operably connected to each of the at least threecapture sections, the linkage assemblies being configured to move the atleast three capture sections between the closed and open configurations,wherein each linkage assembly includes a proximal linkage member and adistal linkage member, the at least one sharpened member being formed onthe distal linkage member.
 2. The surgical instrument of claim 1,wherein the at least three capture sections form a longitudinal cylinderwhen the capture portion is in the closed configuration.
 3. The surgicalinstrument of claim 1, wherein each of the proximal and distal linkagemembers is operably connected to an inner shaft.
 4. The surgicalinstrument of claim 1, wherein the handle assembly includes a triggerfor closing the capture portion.
 5. The surgical instrument of claim 1,wherein the handle assembly includes a release member for opening thecapture portion.
 6. The surgical instrument of claim 1, wherein theelongated body portion includes an inner shaft and an outer shaft. 7.The surgical instrument of claim 1, wherein the at least one sharpenedmember extends radially into the tissue receiving opening.
 8. Thesurgical instrument of claim 1, wherein the at least one sharpenedmember defines an angle from between ten degrees to fifty degrees. 9.The surgical instrument of claim 1, wherein the at least one sharpenedmember defines an angle of about thirty degrees.
 10. The surgicalinstrument of claim 1, wherein the at least one sharpened member isdisposed entirely within the tissue receiving opening.
 11. The surgicalinstrument of claim 1, wherein the first dimension is larger than thesecond dimension.